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Observational Study
. 2024 Feb:10:e2300292.
doi: 10.1200/GO.23.00292.

Clinical Utility of Stepwise Bronchoalveolar Lavage Fluid Analysis in Diagnosing and Managing Lung Infiltrates in Leukemia/Lymphoma Patients With Febrile Neutropenia

Jayashree Thorat  1 , Surabhi Bhat  2 , Manju Sengar  1 , Akshay Baheti  3 , Sweta Bothra  3 , Maheema Bhaskar  4 , Sandeep Prakashnarain Tandon  4 , Sanjay K Biswas  5 , Gaurav V Salunke  5 , George Karimundackal  6 , Virendra Kumar Tiwari  7 , C S Pramesh  8 , Neha Sharma  1 , Venkatesh Kapu  1 , Thomas Eipe  9 , Bhausaheb Pandurang Bagal  1 , Lingaraj Nayak  1 , Avinash Bonda  1 , Amit Janu  3 , Alok Shetty  1 , Hasmukh Jain  1
Affiliations
Observational Study

Clinical Utility of Stepwise Bronchoalveolar Lavage Fluid Analysis in Diagnosing and Managing Lung Infiltrates in Leukemia/Lymphoma Patients With Febrile Neutropenia

Jayashree Thorat et al. JCO Glob Oncol. 2024 Feb.

Abstract

Purpose: Febrile neutropenia (FN) is a serious complication in hematologic malignancies, and lung infiltrates (LIs) remain a significant concern. An accurate microbiological diagnosis is crucial but difficult to establish. To address this, we analyzed the utility of a standardized method for performing bronchoalveolar lavage (BAL) along with a two-step strategy for the analysis of BAL fluid.

Patients and methods: This prospective observational study was conducted at a tertiary cancer center from November 2018 to June 2020. Patients age 15 years and older with confirmed leukemia or lymphomas undergoing chemotherapy, with presence of FN, and LIs observed on imaging were enrolled.

Results: Among the 122 enrolled patients, successful BAL was performed in 83.6% of cases. The study used a two-step analysis of BAL fluid, resulting in a diagnostic yield of 74.5%. Furthermore, antimicrobial therapy was modified in 63.9% of patients on the basis of BAL reports, and this population demonstrated a higher response rate (63% v 45%; P = .063).

Conclusion: Our study demonstrates that a two-step BAL fluid analysis is safe and clinically beneficial to establish an accurate microbiological diagnosis. Given the crucial impact of diagnostic delays on mortality in hematologic malignancy patients with FN, early BAL studies should be performed to enable prompt and specific diagnosis, allowing for appropriate treatment modifications.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/go/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Figures

FIG 1
FIG 1
Baseline screening and enrollment of 122 patients. Clinical, radiologic, and survival outcomes of 102 patients who underwent BAL procedure at the end of fourth week and 12th week. aReasons that characterize physician discretion (n = 37) are BAL procedure deferred by the treating physician (n = 22) because of nondefinitive findings on CT scan and/or having clinical improvement on empirical treatment, definitive organism isolated from blood culture (n = 1), severe grade 4 thrombocytopenia (n = 11), hemodynamically unstable (n = 1), and referred to another center (n = 2). BAL, bronchoalveolar lavage; CT, computed tomography; GCS, Glasgow Coma Scale.
See this image and copyright information in PMC

References

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